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Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, organisational structure and managerial regime within an elaboration of Donabedian’s reasoning about organisational structures. Using new data from England, it considers: how do the internal managerial regimes of differently owned healthcare providers differ, or not? In what respects did any such differences arise from differences in ownership or for other reasons?

An observational systematic qualitative comparison of differently owned providers was the strongest feasible research design. The authors systematically compared a maximum variety (by ownership) sample of community health services; out-of-hours primary care; and hospital planned orthopaedics and ophthalmology providers (n=12 cases). The framework of comparison was the ownership theory mentioned above.

The connection between ownership (on the one hand) and organisation structures and managerial regimes (on the other) differed at different organisational levels. Top-level governance structures diverged by organisational ownership and objectives among the case-study organisations. All the case-study organisations irrespective of ownership had hierarchical, bureaucratic structures and managerial regimes for coordinating everyday service production, but to differing extents. In doctor-owned organisations, the doctors’, but not other occupations’, work was controlled and coordinated in a more-or-less democratic, self-governing ways.

This study was empirically limited to just one sector in one country, although within that sector the case-study organisations were typical of their kinds. It focussed on formal structures, omitting to varying extents other technologies of power and the differences in care processes and patient experiences within differently owned organisations.

Type of ownership does appear, overall, to make a difference to at least some important aspects of an organisation’s governance structures and managerial regime. For the broader field of health organisational research, these findings highlight the importance of the owners’ agency in explaining organisational change. The findings also call into question the practice of copying managerial techniques (and “fads”) across the public–private boundary.

Ownership does make important differences to healthcare providers’ top-level governance structures and accountabilities and to work coordination activity, but with different patterns at different organisational levels. These findings have implications for understanding the legitimacy, governance and accountability of healthcare organisations, the distribution and use power within them, and system-wide policy interventions, for instance to improve care coordination and for the correspondingly required foci of healthcare organisational research.

The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.

The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners.

The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups.

The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction.

The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction.

The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.

Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds. Managerial workarounds have seldom been analysed. This paper does so by extending and modifying existing knowledge of the causes and character of clinical and IT workarounds, to produce a conceptualisation of the managerial workaround. It further develops and revises this conceptualisation by comparing the practical management, at both provider and purchaser levels, of hospital DRG payment systems in England, Germany and Italy.

We make a qualitative test of our initial assumptions about the antecedents, character and consequences of managerial workarounds by comparing them with a systematic comparison of case studies of the DRG hospital payment systems in England, Germany and Italy. The data collection through key informant interviews (N = 154), analysis of policy documents (N = 111) and an action learning set, began in 2010–12, with additional data collection from key informants and administrative documents continuing in 2018–19 to supplement and update our findings.

Managers in all three countries developed very similar workarounds to contain healthcare costs to payers. To weaken DRG incentives to increase hospital activity, managers agreed to lower DRG payments for episodes of care above an agreed case-load ‘ceiling' and reduced payments by less than the full DRG amounts when activity fell below an agreed ‘floor' volume.

Empirically this study is limited to three OECD health systems, but since our findings come from both Bismarckian (social-insurance) and Beveridge (tax-financed) systems, they are likely to be more widely applicable. In many countries, DRGs coexist with non-DRG or pre-DRG systems, so these findings may also reflect a specific, perhaps transient, stage in DRG-system development. Probably there are also other kinds of managerial workaround, yet to be researched. Doing so would doubtlessly refine and nuance the conceptualisation of the ‘managerial workaround’ still further.

In the case of DRGs, the managerial workarounds were instances of ‘constructive deviance' which enabled payers to reduce the adverse financial consequences, for them, arising from DRG incentives. The understanding of apparent failures or part-failures to transform a health system can be made more nuanced, balanced and diagnostic by using the concept of the ‘managerial workaround'.

Managerial workarounds also appear outside the health sector, so the present analysis of managerial workarounds may also have application to understanding attempts to transform such sectors as education, social care and environmental protection.

So far as we are aware, no other study presents and tests the concept of a ‘managerial workaround'. Pervasive, non-trivial managerial workarounds may be symptoms of mismatched policy objectives, or that existing health system structures cannot realise current policy objectives; but the workarounds themselves may also contain solutions to these problems.

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

Healthcare organizations worldwide were badly hit by the “surprise” of the pandemic. Hospitals in particular are trying hard to manage problems it caused, searching for solutions to protect the health of citizens and reorienting operations. The implementation of resilience solutions in the coping phase and the ability to react promptly and redefine activities is essential. Integrating crisis management and resiliency literature, this paper discusses how health organizations were able to cope with adversity during the crisis.

The research is conducted through a case study of a large Italian hospital, the Gemelli Polyclinic Foundation, which was one of the leading hospitals in the Italian response to the pandemic.

The case reports actions taken in order to continue functioning and to maintain core activities despite severe adversity. The overall response of the Gemelli was the result of the three types of response: behavioral (effective leadership), cognitive (rapid resource reallocation) and the contextual reinforcement (multiagency network response). The authors highlight how an integrative framework of crisis management and resiliency could be applied to healthcare organizations in the coping phase of the pandemic. The experience of the Gemelli can thus be useful for other hospitals and organizations facing external crises and for overall improvement of crisis management and resilience. Responding to crisis brings the opportunity to make innovations introduced during emergencies structural, and embed them moving forward.

The paper focuses only on the coping phase of the response to the pandemic, whereas building long-term resilience requires understanding how organizations accumulate knowledge from crises and adapt to the “new normal.”

The paper responds to the call for empirical studies to advance knowledge of an integrative framework of crisis management and resiliency theories with reference to complex organizations such as healthcare.

The study examined the utilisation patterns of healthcare services among tea garden workers and analysed the factors influencing utilisation in an Indian context.

The authors employed a mixed-method approach and an explanatory sequential design for the study. A survey was conducted in the beginning followed by in-depth interviews in a north-eastern state of India (Assam). Andersen health behaviour model was used to explore the factors influencing healthcare utilisation. The sample size for the survey and in-depth interviews were 300 and 19, respectively, recruited employing multistage random and purposive sampling techniques.

Out of 300 workers surveyed, 169 (56.3%) were females, 257 (85.7%) were married, 77 (25.7%) were illiterates and 229 (76.3%) had monthly household income less than 100 US$. The survey also found that 47.3% and 15.3% had non-communicable and communicable disease respectively. Most of the workers (67.3%) utilised government facilities, and close to one third (28.7%) utilised tea garden hospitals. About 63.3% had health insurance, but a majority (78.9%) did not use it previously. The analyses of interviews explored the need, enabling, predisposing factors under three important themes influencing utilisation of healthcare services among the workers.

The study generates evidence to strengthen the Indian Plantation Labour Act, 1951 for tea garden worker's welfare protection and warrants transition from colonial-era policies to contemporary industry realities in order to improve their living, employment, nutritional and health conditions.

The research adds to the existing literature on overall healthcare services utilisation (including coverage and utilisation of health insurance) among blue collar workers who usually lack access to healthcare facilities and explores important factors that determine utilisation in the Indian context.

This paper aims to examine the relationship between psychiatry and occupational therapy in Ireland through a case study of the development of the occupational therapy department in St. Patrick’s Hospital, Dublin, from 1935 to 1969. Patronage by psychiatrists was an important factor in the professionalisation of occupational therapy internationally.

Documentary sources and oral history interviews were analysed to conduct an instrumental case study of occupational therapy at St. Patrick’s Hospital from 1935 to 1969.

The research identified key individuals associated with the development of occupational therapy at St. Patrick’s Hospital, including psychiatrist Norman Moore, occupational therapy worker Olga Gale, occupational therapist Margaret Sinclair, and social therapist Irene Violet Grey. Occupational therapy was considered by the hospital authorities to be “an important part in the treatment of all types of psychiatric illness” (Board Meeting Minutes, 1956). It aimed to develop patient’s self-esteem and facilitate social participation. To achieve these objectives, patients engaged in activities such as dances, arts and crafts, and social activities.

This study has highlighted the contributions of key individuals, identified the links between occupational therapy and psychiatry, and provided an insight into the development of the profession in Ireland prior to the establishment of occupational therapy education in 1963. Occupational therapy practice at St. Patrick’s Hospital from 1935 to 1969 was congruent with the prevailing philosophy of occupational therapy internationally, which involved treatment through activities to enhance participation in society.

The past decade has witnessed a tremendous and progressive growth in the number of Nigerians who engage in medical tourism from Nigeria to India. Various commentators have advanced diverse reasons for this trend. However, there is a dearth of research that has sought to provide empirical insights. This paper aims to investigate the decision-making process of Nigerian medical tourists and why they prefer medical tourism to India to medical care locally.

Eight Nigerian medical tourists are interviewed on a one-on-one basis with open-ended questions using purposive criterion sampling technique from an interpretivist mind-set.

The paper identifies two major motivators, namely, inadequate medical infrastructure and poor medical, and customer service from health workers in Nigeria, which spurred medical tourism from Nigeria to India. Further, it finds that first timers premise their decisions on advice from reference groups, while previous personal experiences guide decisions on subsequent medical travels. Findings are explained using the template provided by the theory of planned behaviour.

This exploratory nature of this research provides a useful basis to elucidate the course of decision-making of Nigerian patients so that appropriate marketing communication channels can be applied. It improves the process of recruiting and engaging Nigerian patients and nurturing wholesome relationships between Nigerian patients and hospitals.

This paper aims to address research gaps with regard to the relationship between market orientation and marketing performance when small- and medium-sized enterprises (SMEs) are located within a service cluster. The three main objectives of this research are to determine the effect that the cluster can have on both the market orientation of clustered companies and their marketing performance and to furthermore evaluate the effect of the market orientation of companies in the cluster on their marketing performance.

This research used executive-level data that were obtained by carrying out a survey involving a unique dataset of 133 Colombian health-related businesses located in the city of Cali (Colombia) in 2014. A system of equations was modeled using SMART PLS. This analysis was complemented by a qualitative study that involved conducting in-depth interviews in six companies.

The results showed that, among the SMEs, membership in an urban services cluster did not significantly influence marketing performance or the implementation of marketing orientation practices. No differences were observed in internal managerial practices implemented between companies that were co-located and isolated. However, a higher level of competitor orientation was associated with greater marketing performance. Given the verified absence of moderating and mediating effects, our work provides a reasonable basis for proposing future research and practical recommendations.

While research has demonstrated the relationship between a company's market orientation and marketing performance, this type of analysis has not been carried out on service SMEs in geographic concentrations or clusters.

本文旨在處理涉及市場導向與營銷績效間的關係的研究缺口. 當中小型企業處於服務群集內, 市場導向與其營銷績效間存在相互關係；本文旨在處理涉及這關係的研究缺口. 本研究有以下的主要目標：（1）找出群集對群集公司的市場導向及其營銷績效兩者的影響；（2）繼而評估在群集內公司的市場導向對其營銷績效的影響.

本研究使用透過進行一項調查而取得的管理階層數據，而這調查涉及於2014年位於卡利市（哥倫比亞）133間與健康衛生有關的哥倫比亞企業的獨特資料集。一個方程式體系透過使用SmartPLS被模擬出來. 這分析有個補充輔助，就是一個涉及在六間公司內進行的深層訪談的質性研究.

研究結果顯示，就有關的中小型企業而言，擁有城市服務群集身份並沒顯著地影響營銷績效或市場導向慣常做法的施行。對處於同一地點的公司，抑或是隔離的公司，其內部施行的管理慣常做法並沒觀察到有所不同。但是，高水平的競爭者導向與更佳的營銷績效兩者是相關的。考慮到調節及仲介效果被證實不存在，我們的研究為日後研究及實際建議的提出提供合理的基礎.

從前的研究證實了公司的市場導向與營銷績效是相關的，唯這類研究分析從來沒有在地理集中或群集內的服務中小型企業上進行過.

The aim of our research is to give empirical and theoretical solutions to some criticalities of the original International Integrated Reporting Framework (IIRF). Indeed, it takes as value creation only the increase of the capitals triggered by business activities, overlooking the fulfilment of the institutional mission that is the actual value creation lever.

The present paper introduces a case study aimed at implementing the IIRF in an Italian non-profit healthcare organisation. The research is based on theory building from cases, action research and interventionist approach. IIRF was adopted because of its claimed ability to support the communication process to stakeholders and the control of value creation. However, IIRF shows several weaknesses.

An adjusted version of IIRF is suggested, highlighting the role played by IC in the organisational business model and in the value creation process. The adjusted seems able to foster awareness of the role IC in value creation in healthcare organisations.

In this paper no one of the singles pieces of the adjusted framework is innovative by itself, but jointly they give raise to an innovative solution, able to address the disclosing and managerial needs of the examined organisation. The single case study permits to us to test the weaknesses of the IIRF claimed in the literature, to suggest some adjustments to the original framework and to validate their effectiveness. Thanks to the single case study we then built theoretical constructs developing theory inductively; now the suggested framework can be further tested and validated in other organisations.

The paper introduces an innovative approach to IC reporting and disclosure in healthcare organisations. This is relevant not only for external communication but also for internal aims supporting managers in decision and actions.